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Diabetic myonecrosis or muscle infarction (DMI), a clinicoradiological entity is an underdiagnosed complication of diabetes mellitus. It refers to spontaneous aseptic necrosis of skeletal muscles commonly of the lower limb without evidence of any large vessel disease. It presents as painful swollen limb without any external insult in patients with long-standing diabetes mellitus with other microvascular complications especially nephropathy. We present four instances of DMI in our patients who had end-stage renal disease with a varied course.
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Background@#This study evaluated the outcomes of patients with refractory/relapsed Hodgkin lymphoma (RRHL) treated with a bendamustine-based regimen in combination with ifosfamide, etoposide, and vinorelbine (VIBE). @*Methods@#Consecutive RRHL patients who were treated with the VIBE regimen were identified and studied for clinicopathologic characteristics, response to VIBE regimen, event-free survival (EFS), and feasibility of an autologous stem-cell transplant (autoSCT). @*Results@#In total, 24 patients received the VIBE regimen, and a median of 3 cycles were administered. In this cohort, 80% of the patients had received ≥2 prior lines of therapy. The overall and complete response rates with VIBE were 79% and 42%, respectively. After a median follow-up (following VIBE regimen) of 14 months (range, 3‒76), the 3-year EFS and OS were 46% and 74%, respectively. Of the eligible patients, 92% underwent successful AutoSCT. The mean CD34+ cell count in the autograft was 5.5×106/kg (SD 2.07). Neutropenia was the commonest hematologic toxicity and it was observed in 42% of the patients. However, only 9% of the patients developed grade III/IV febrile neutropenia. Chemotherapy-induced nausea and vomiting were the second most common grade III/IV toxicities in our cohort of patients. @*Conclusion@#In this retrospective analysis, the combination regimen, VIBE, has shown good efficacy in heavily pre-treated patients with RRHL without compromising stem cell collection. These encouraging results provide a rationale for further development of this regimen.
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Background@#This study evaluated the outcomes of patients with refractory/relapsed Hodgkin lymphoma (RRHL) treated with a bendamustine-based regimen in combination with ifosfamide, etoposide, and vinorelbine (VIBE). @*Methods@#Consecutive RRHL patients who were treated with the VIBE regimen were identified and studied for clinicopathologic characteristics, response to VIBE regimen, event-free survival (EFS), and feasibility of an autologous stem-cell transplant (autoSCT). @*Results@#In total, 24 patients received the VIBE regimen, and a median of 3 cycles were administered. In this cohort, 80% of the patients had received ≥2 prior lines of therapy. The overall and complete response rates with VIBE were 79% and 42%, respectively. After a median follow-up (following VIBE regimen) of 14 months (range, 3‒76), the 3-year EFS and OS were 46% and 74%, respectively. Of the eligible patients, 92% underwent successful AutoSCT. The mean CD34+ cell count in the autograft was 5.5×106/kg (SD 2.07). Neutropenia was the commonest hematologic toxicity and it was observed in 42% of the patients. However, only 9% of the patients developed grade III/IV febrile neutropenia. Chemotherapy-induced nausea and vomiting were the second most common grade III/IV toxicities in our cohort of patients. @*Conclusion@#In this retrospective analysis, the combination regimen, VIBE, has shown good efficacy in heavily pre-treated patients with RRHL without compromising stem cell collection. These encouraging results provide a rationale for further development of this regimen.
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Basophilia is commonly associated with chronic myelogenous leukemia, notably in the accelerated phase or during blast crisis. It is also associated with other myeloproliferative neoplasms. However, its association with acute leukemia is very rare and is described in association with acute basophilic leukemia and few acute myeloid leukemias [AMLs] with recurrent genetic abnormalities such as t[6;9][p23;q34]. Herein, we describe the morphological features and discuss the differential diagnosis of a case of AML with the blasts showing previously unreported unusual combination of megakaryoblastic and basophilic differentiation along with peripheral blood and bone marrow basophilia
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Neurolymphomatosis (NL) defined as infiltration of the central nervous system or the peripheral nervous system (PNS) by malignant lymphoma cells is a rare clinical entity. However, the increasing use of fluorodeoxyglucose positron-emission tomography (FDG-PET) and magnetic resonance imaging in evaluating PNS disorders is resulting in; this condition being recognized more frequently. Here; we report five NL patients and review the current literature. We report five patients with non-Hodgkin's lymphoma (NHL) and NL, all of whom were men aged 47-69 years. The clinical presentation varied from symmetrical peripheral neuropathy to mononeuropathy. Peripheral neuropathy was the presenting manifestation of a systemic lymphoma in two patients (40%). Neuroimaging as well as whole-body FDG-PET helped in determining the correct diagnosis in all of the patients. NL is an unusual presentation of NHL resulting from infiltration of the PNS by malignant lymphomatous cells. While evaluating peripheral neuropathy, a high degree of suspicion of NL is required since the presenting symptoms vary, conventional radiology has only modest sensitivity, and a pathological diagnosis is often difficult. FDG-PET helps in the early diagnosis and treatment of this condition.
Subject(s)
Animals , Humans , Male , Central Nervous System , Diagnosis , Early Diagnosis , Lymphoma , Lymphoma, Non-Hodgkin , Magnetic Resonance Imaging , Marek Disease , Mononeuropathies , Neuroimaging , Peripheral Nervous System , Peripheral Nervous System Diseases , Positron-Emission TomographyABSTRACT
Neurolymphomatosis (NL) defined as infiltration of the central nervous system or the peripheral nervous system (PNS) by malignant lymphoma cells is a rare clinical entity. However, the increasing use of fluorodeoxyglucose positron-emission tomography (FDG-PET) and magnetic resonance imaging in evaluating PNS disorders is resulting in; this condition being recognized more frequently. Here; we report five NL patients and review the current literature. We report five patients with non-Hodgkin's lymphoma (NHL) and NL, all of whom were men aged 47-69 years. The clinical presentation varied from symmetrical peripheral neuropathy to mononeuropathy. Peripheral neuropathy was the presenting manifestation of a systemic lymphoma in two patients (40%). Neuroimaging as well as whole-body FDG-PET helped in determining the correct diagnosis in all of the patients. NL is an unusual presentation of NHL resulting from infiltration of the PNS by malignant lymphomatous cells. While evaluating peripheral neuropathy, a high degree of suspicion of NL is required since the presenting symptoms vary, conventional radiology has only modest sensitivity, and a pathological diagnosis is often difficult. FDG-PET helps in the early diagnosis and treatment of this condition.
Subject(s)
Animals , Humans , Male , Central Nervous System , Diagnosis , Early Diagnosis , Lymphoma , Lymphoma, Non-Hodgkin , Magnetic Resonance Imaging , Marek Disease , Mononeuropathies , Neuroimaging , Peripheral Nervous System , Peripheral Nervous System Diseases , Positron-Emission TomographyABSTRACT
BACKGROUND: Plasma cell leukemia (PCL) is a rare and aggressive plasma cell neoplasm. In PCL, clonal plasma cells comprise ≥20% of the peripheral blood (PB) leukocytes and/or the absolute clonal PB plasma cell count is ≥2×10(9)/L. Primary PCL (PPCL) originates de novo, whereas, secondary PCL (SPCL) evolves from pre-existing multiple myeloma. METHODS: Clinicohematological features, immunophenotypic profile, and survival of PCL patients were analyzed retrospectively. RESULTS: Between January 2007 and December 2014, ten PPCL and four SPCL patients were investigated (8 PPCLs and 3 SPCLs had complete clinical data). All were North Indians, sharing common geography and ethnicity. Our cohort showed less frequent renal failure, more frequent hepatomegaly, and non-secretory type disease. In contrast to western literature, flow cytometric immunophenotyping of our cohort revealed altered expression of CD138 (67%), CD56 (33%), and CD20 (0%). With novel therapeutic agents, these PPCL patients had a median overall survival of 15 months. CONCLUSION: We highlight that our PPCL patients from North India had distinct clinicohematological and immunophenotypic profiles. The significance of our findings must be tested in a larger patient cohort and must be supported by molecular and cytogenetic investigations to unmask possible significant effects on pathogenesis.
Subject(s)
Humans , Cohort Studies , Cytogenetics , Geography , Hepatomegaly , Immunophenotyping , India , Leukemia, Plasma Cell , Leukocytes , Multiple Myeloma , Neoplasms, Plasma Cell , Plasma Cells , Plasma , Renal Insufficiency , Retrospective Studies , Tertiary Care Centers , Tertiary HealthcareABSTRACT
In this article, we report the spontaneous dissolution of a long cotton thread in the laser in situ keratomileusis [LASIK] flap interface. In this observational case report, sequential follow-up of a post-LASIK eye with a long cotton fiber noticed in the LASIK interface was performed. The postoperative course was uneventful, with no evidence of infection, uveitis, or any other complications. The cotton thread underwent spontaneous dissolution. Conservative management of a cotton fiber, not causing any symptoms and noticed after the immediate postoperative follow-up period is over, seems to be a possible alternative to flap relift and intervention
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To analyze the anatomical and functional outcome of glued intra ocular lens [IOL] implantation technique and its modifications. Design: Retrospective observational case series. This is a retrospective analysis of the patients who underwent glued intra ocular lens implantation from December 2007 to August 2010. Post operative uncorrected vision, best corrected visual acuity [BCVA], intra ocular pressure, IOL position, endothelial cells and anterior chamber reaction at their last follow up are analyzed from their concerned case sheets documentation. Subjective changes are analyzed via individual questionnaire. Immediate and late postoperative complications are also evaluated. Surgical modifications and the difference in the operated eyes are analyzed. Total 210 glued IOL eyes have been reviewed. Out of this 210, there are 152 [PMMA glued IOL] 21 [three piece foldable IOL], 5 [multifocal foldable IOL], 12 [pediatric glued IOL], 5 [20G sutureless vitrectomy], 2 [glued iris prosthesis] and 3 [transposition of posterior chamber IOL into anterior chamber]. In combined surgeries there are, 5 [optical penetrating keratoplasty], 2 [desc-emet's stripping endothelial keratoplasty] and 3 [iridoplasty]. The modifications in glued IOL are handshake technique, injectable or foldable glued IOL, Multifocal glued IOL and intraoperative 23/25G trocar cannula infusion. Decentration [1.97%], macular edema [1.97%] and optic capture [2.63%] are the post operative complications encountered in rigid glued IOL. Good patient satisfaction is seen in the eyes with IOL repositioning, IOL exchange and multifocal glued IOL. There is significant improvement in BCVA in PMMA IOL [p = 1.35xl0[-5] and foldable IOL [p = 0.000]. Glued IOL seems to be a good alternative in IOL implantation in eyes with deficient capsules. The modifications in the existing technique decrease the learning time and risk for complications